Alzheimer's & dementia : the journal of the Alzheimer's Association
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The North American Alzheimer's Disease Neuroimaging Initiative (ADNI) was originally conceived as a study to develop markers of disease progression, but has also become a strong technological platform for the multi-centric collection of clinical data and imaging and biological markers. Because the ADNI platform was first imported in Europe, thanks to the pilot European ADNI, several ADNI-related initiatives have flourished, funded by the European Commission's 7th Framework Programme, national governments, and the Alzheimer's Association aimed at: (i) collecting fresh data ADNI style (FP7 AddNeuroMed, Innovative Medicine Initiative Pharma-Cog/European ADNI, Swedish ADNI, and Italian ADNI); (ii) developing standard operational procedures for the collection of markers (International Harmonization of CSF Abeta42 and tau, and European Alzheimer's Disease Consortium-ADNI Harmonization of Hippocampal Volumetry); and (iii) developing infrastructures for the treatment of ADNI data (FP7 neuGRID and outGRID, and the French Centre pour l'Acquisition et le Traitement de l'Image). Although this fragmented scenario is not surprising given the structure of scientific funding in Europe, opportunities are being developed for high order networking and harmonization at the continental level (Joint Programming for Neurodegenerative Diseases).
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The published proceedings of the second Annual Leon Thal Symposium (Alzheimers Dement 2009;5:85-92) have added to the open discussion among leaders in this field, with respect to the development of a national strategy for accelerating the discovery of preventative interventions for Alzheimer's disease. One of the recommended "action steps" detailed in that report centers on the establishment of a National Institutional Review Board for neurodegenerative diseases. ⋯ This essay expands on this recommendation, and two potential organizational models are briefly considered. A well-designed, highly-qualified, and responsive National Institutional Review Board for neurodegenerative diseases would serve the direct interest of protecting the rights, welfare, and safety of our older citizens, who so generously contribute their time, energy, and comfort to advance research to discover new treatments for this devastating disease.
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The past 30 years have seen multiple attempts at demonstrating the safety and efficacy of drugs for Alzheimer's disease (AD), predominantly to improve symptoms. Only five drugs (tacrine, donepezil, rivastigmine, galantamine, memantine) have obtained regulatory approval in most countries. ⋯ There have also been attempts at arresting progression of AD, but all have failed until now. Should we change our approach to developing new drugs for AD so as to move forward? This review will highlight some options to consider in the development of future drugs for AD, with emphasis on strategies to prevent AD or arrest its progression.
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The Memory Performance Index (MPI) quantifies the pattern of recalled and nonrecalled words of the Consortium to Establish a Registry for Alzheimer's Disease Wordlist (CWL) onto a 0 to 100 scale and distinguishes normal from mild cognitive impairment with 96% to 97% accuracy. ⋯ MPI score progressively declines with increasing dementia severity. Also, MPI score explains 2 to 3 times more variance than total scores, which improves ability to detect treatment effects.